Severe sepsis criteria, PELOD-

2, and pSOFA as predictors of

mortality in critically ill
children with sepsis
CRITICAL APPRAISAL : PROSPECTIVE COHORT STUDY

Ina, Lestari, Lima, Tiwi, Wury

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all pediatric patients diagnosed with sepsis based on the SIRS criteria
P
The data were taken from laboratory and physical examinations by the

I physicians on duty

To compare the accuracy of three mortality predictor tools: severe sepsis criteria,
pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ
C failure assessment (pSOFA), in critically ill children with sepsis

better predictor of mortality

O
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1 Was the cohort representative of the population?

Was everyone included who should have been?

1. Yes.
2. No, because the research exclude patients
with previously known malignancy, hematological
abnormalities, or congenital heart, lung, or kidney
anomalies were excluded from the study
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2 Were the methods for determining exposure

objective and consistent across the cohort? Were
the tools validated, where applicable?

Yes, because the study started in September 2018

ended in March 2019 and employed a consecutive
sampling method
Yes, the tools used in this study like SIRS, PELOD,
and pSOFA were validated and applicable.
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3 Were the methods for determining outcome objective and

consistent across the cohort? Were the tools validated, where
applicable?

1. Yes, The prognostic accuracy of the three methods of

assessment for sepsis (severe sepsis criteria, PELOD-2, and
pSOFA ) can be compared with various diagnostic parameters
the methods for determining outcome (mortality predictor).
2. Yes, the tools were validated. Because the study use
95%CI and p<0,05
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4 Were the subjects and/or the outcome

assessor blinded to exposure?

No. Because the study use exclusion

criteria to choose the subjects like
previously known malignancy,
hematological abnormalities, or congenital
heart, lung, or kidney anomalies.
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5 Have all important confounding factors been

identified and accounted for in the design
and/or analysis?

No. The study doesn’t limit age as confounding

factor for the subject criteria. In the discussion,
mentioned that younger age has been
associated with immune system immaturity and
is usually accompanied by comorbidities.
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6 Was follow-up of subjects

complete? and sufficiently long?

Yes, because there are no subject

drop out from the study.
Yes, because the study start within
6 months and the mean of length
of stay (LOS) was 8,7 days.
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What were the results?

How strong is the

association between
exposure and outcome
(relative risk)? What is
the absolute risk
reduction (risk
difference)?
From three methods, only
pSOFA has strong asosiation
with outcome (P=0.039).
However severe sepsis
criteria, and PELOD-2 were
not significant predictors for
mortality (P> 0.05).
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What were the results?

How precise is the

estimate of risk
(confidence intervals)?

The OR value for the pSOFA was

also the highest at 10.111 (95%CI
1.054 to 97.002).
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How can I apply the results to my patient care?

Yes, because of the

Were the study
study used 95%CI
patients similar to
and represents the
my patient?
population

Is the exposure
similar to what
might occur in my
patient?

Are there benefits

that offset the risks
of the exposure?
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Thanks!
Any questions?